The Art of Bracing and What You Need to Be Aware Of

This week we're talking about the art of bracing and what you need to be aware of, so lots of conversations around bracing and what that's used for. So last episode, we talked about kind of the details of what that looks like, and just some general basic information. And today I wanna talk about more how it applies to you and how we use bracing. So traditionally speaking, when we're talking about bracing, most of the time we're talking about either juveniles or adolescents, kids that are growing, that are diagnosed with either scoliosis or hyper kyphosis that are wearing a brace because they're growing.

And essentially what that means is when kids are growing, if they've got a scoliosis, if they're not in a corrected position as they grow, that curve can progress. When the spine grows and growth plates continue to grow, when there's pressure on certain sides of that growth plate, the the bone and the spine will actually start to grow in a deformity.

So that's essentially what the goal is for bracing in kids that are growing. And that's why when you go see an orthopedic surgeon or any other primary care provider that works with scoliosis, if you have a child that's got a scoliosis or a hyper kyphosis and they're growing, they're going to put them in a brace.

So that's pretty straightforward. That's general recommendations. Everybody that would see a case like that should be doing that if that's where you're at. And then based on where they're at, specifically with their age and where their growth plates are at, the severity of their curve, lots of different things.

Family history, that's where they determine, you know, are you wearing a brace? How long are you wearing a brace? What kind of brace? So whether that's a brace at night or that's a full-time brace or what that might look like. So that's pretty general, and I would say most people know that that's something that's coming.

If you have a child that's growing with a scoliosis. So here's where the intricate pieces come in because there's a lot of different recommendations across providers, and I've personally had conversations with families and even other providers about these scenarios and then different recommendations and why they might be different.

So that's really what I wanna speak into because there can be some confusion, and I know when parents come in. You come in and you talk to us in our office, and then for whatever reason, whether it's insurance or a second opinion, or maybe there's something else going on, you go see an orthopedic surgeon, they give you a different recommendation.

That orthopedic surgeon says, "Hey, why don't you see our physical therapist while you're here?" And then you go see the physical therapist. And the physical therapist gives a different recommendation from the orthopedic surgeon and from our office, right? And then you're left with three different recommendations.

And they're kind of all similar, but they're also different. And then you leave all of these appointments and it's overwhelming. So I wanna help clear some of that up today because there is different scenarios, and different goals and purposes that play into some of these recommendations. And so I'm gonna speak about a scenario that happened in my office that looking back at that, I was like, gosh, you know, we really should have been more clear in some of this information because it would've been really helpful.

So, say you have a child who maybe is a little bit older, say they're 13, 14 years old, they are more towards the end of their growth. So they measure that. If you're not familiar, they talk about like, Risser sign, right? So Risser 0, 1, 2, 3, 4, 5. So, Risser five done growing. Growth plates are closed.

If you are like Risser one , 2 0 1 2, you know, you're still gonna be growing. You've got that fast growth phase coming up. You know, Risser three. So they base it off of those classifications. So if you're not familiar with that, of course you can always go Google it and you can look and see what it, what it shows as far as the bone and what that means and what that looks like.

So we've had more than one case where somebody will come into our office and they've never been diagnosed with a scoliosis or anything. They come in, we find that they have a scoliosis. We take an x-ray, and it's in this range of say like 27 to 35 degrees. And patient might be between the ages of like 13, 14, 15 , maybe they've already had their menstrual cycle for a while, and we look at their growth plates and they're like a Risser four.

So when we're looking at that and parents are coming in, some of the history of that might be, you know, our child's really active, they're having some trouble with sports, or maybe they're having trouble pitching in softball. They're having pain in their back. They're concerned about their posture.

You know, most of the time it's girls like going into high school that, you know, in a swimming suit, they're like, gosh, you know, this one rib is sticking out, or my shoulder is down. When I put on my clothes, my clothes sit funny. And so they're coming in with these concerns, but then also the parents are maybe new to this too. And they're wondering, okay, well we have this curve, like we don't want our child to have surgery and you know, this is at 28 degrees or 32 degrees, you know, whatever it might be. And so what do we do with this? And so from our lens. So using a ScoliBrace®, when we're looking at that based off of our braces that we provide, that are made through 3D technology that are over corrective, that when we fit you with that brace, we actually get correction in that brace.

When we're looking at that, we approach that scenario from knowing that if you've got a curve that's under 30 degrees, when you are done growing, it's less likely to progress as an adult. So essentially what that means is if you've got a 32, 35, 36 degree curve, even if you're done growing, those curves can progress as you age through your adult life.

So especially if we've got a kid in that range, they're having pain, it's affecting their daily life, even if they're close to done growing. We can utilize that brace to give correction in the brace, and if the patient is compliant, we've been able to get correction of those curves where.

We look at multiple things.

Are we able to reduce pain? Are we able to help correct the posture to make their posture more balanced? So essentially their body functions better, more biomechanically, and also they have less postural issues, meaning that aesthetically then that child is happier with what their posture looks like.

But then also a goal of, can we reduce the curve, keep it under 30, or if it's over 30, can we get it under 30? Even though they might be a little bit older than say what an orthopedic surgeon might brace. And so we've had these conversations and we've chatted about this and then, you know, for whatever reason it might be, they go see an an orthopedic surgeon.

And the orthopedic surgeon is like, "well, they're Risser four. Um, they've had their menstrual cycle for a while and their curve is 27 degrees or 33 degrees, and so essentially they're kind of done growing, so they don't need a brace, you know, no worries. Go see our rehab person. They'll work with you and then we'll see you in six months."

Or maybe, you know, sometimes they might say 12 months. Depends on where they're at. Then they go see the rehab person and they'll show them some exercises and they'll say, okay, here's your exercises. When you come back in three months, six months, or whatever it might be. Then we'll go through them again, and then the family leaves and comes back, and then we get a phone call, talking about saying like, well, the orthopedic surgeon said we didn't need a brace.

The rehab person said that we just need to do these exercises and come back in. Six months, three months, whatever it might be that we don't need to do this regularly. And then it comes back to the conversation we had where we were talking about utilizing a brace and utilizing our specific rehab program that we have, which essentially, depending on the patients as far as like the, how often we see them, but we generally do like a 12 session program initially and hopefully see those, that patient every week for 12 weeks to build on that.

It's very corrective focused and specific, and it's a scoliosis specific exercise rehabilitation program. So as you can imagine coming back from all of these recommendations, we now have three different providers, three different recommendations and three different pieces of information. And the reality is that they're all accurate.

Which is frustrating. And so that might sound odd when I say they're all accurate to you, because when I think of something like, well, somebody has to be right, like who's giving the bogus recommendation, right? But it depends on the lens in which you're looking at it. So when we work with families and when we work with you, we look at what are our concerns?

Where are we at? Right now, let's lay out the information and then let's make recommendations that, first, make sure that, you know, medically speaking, we're doing the right treatment protocols to make sure that you're safe and we're preventing any sort of, you know, negative thing from happening. Meaning we don't want your child to go to surgery.

But then also what are the concerns that you came in with and how do we work with that, right? So, here are the different lenses. So that family that I spoke about, when we come in and we look at through that lens, yes, they're almost growing, done growing, but we still have an opportunity to make change.

We're focusing on being proactive. Reducing the curve as much as possible so that they can have a better long-term prognosis as an adult functioning throughout their life. Especially if they're already having symptoms, if they're already noticing postural effects, if it's already making them self-conscious, if it's already affecting their mental and emotional wellbeing in that sense, right.

As they get older, those things will only continue to progress, right? Because in general, say you had a perfect healthy spine. We all know as we age, things start to have wear and tear. It start to degenerate. It's not uncommon that adults in their fifties, sixties, seventies, have degeneration in their spine, in their joints because you've used them for 60 years.

So if you've got a curve in your spine, it's more likely that you're going to start to see those changes in that breakdown. Faster as you age, especially if those curves are over 30 degrees. So we're looking at it from that lens of how can we best serve you using the tools that we have that we know are effective?

And so if we shift over to say, the orthopedics point of view, they're looking at that as. Okay, this child is almost done growing. They've had their menstrual cycle. The curve is either it's right under 30 or over 30, right in that area. And so knowing that they're, say like a Risser four, it's less likely that you're going to have progression of that curve.

So when they're looking at it from, is this kid going to end up having to have surgery? Unlikely is the answer. So from their perspective of what they're evaluating is, is this a child I'm gonna have to do surgery on if we don't intervene? If the answer's no, they typically don't do anything with that. And also depending on what braces they provide at their facility, oftentimes the braces that they might have available to them are more stabilization braces.

So they may not actually get correction of the spine and the braces they have to offer. And so if that's the case, then they're right. It's not worth having a brace because it's not going to do anything to make it better. And if there's a low risk of it getting worse, they wouldn't use that brace. So that makes sense.

So they're giving a solid recommendation, even though it might be different then the recommendation we've given. And then fast forward, so say now you're done with the orthopedic surgeon. You go see the rehab physical therapist that they have there, and maybe they've had some courses in say, Schroth or some scoliosis training or some other PSSE program that's different, right?

So each program is different and the applications are different. And especially if you're coming from a distance, right? If you are driving 400 miles, one way to go to this specialty hospital. There is almost a 0% chance that you're coming back weekly to see these rehab specialists. So they have to fit their program differently because it's just not realistic that people coming from a long way away are going to be able to come in regularly or build a program around that.

So that being said, that's a piece of it, right? But then they also aren't familiar in the rehab programs that we have available in our office. And that conversation comes up where they'll say, you know, I'm not familiar with that program, so I don't know, based on our program, you shouldn't have to come in as often, but we can't speak to each other's programs because we're not necessarily familiar with it, and we're not trained in that.

So then you hear a different recommendation from yet another provider who's doing the rehab. And you can even potentially, I had this happen once where the orthopedic doctor had made a recommendation for rehab and then when that patient got to the physical therapist's office, the physical therapist was like, oh, actually no, I don't agree with that recommendation.

After seeing you, this is what we need for rehab. And then that conversation comes in of like, well, the orthopedic doctor knows the general consensus of rehab, but based off of my evaluation, it really needs to look like this. And so it can get really confusing and really muddled. And so that's what I want to just open up the conversation about because it's not always, it's never actually black and white.

Every single patient, every single scoliosis, every single presentation is different. I have never had one, like more than one patient that I have managed or gave recommendations to exactly the same. It just doesn't happen because you have different activities. Patients live different distance distances from you.

There's different abilities for compliance based off of your life. Other medical diagnosis and, just like so many different factors, and underlying family history. And in addition to that, you know, one of the things that has recently come up, and this is knowledge really for anybody across the board, whether you're a parent, whether you're a provider, listening to this, there's even scenarios where I was just having a conversation about this with another provider, so.

If you approach every scoliosis case the same, there is no doubt that at some point something really not great will happen because they are not the same. So I recently had the conversation of there was one patient in one office that was, I believe, I can't remember the exact age, but I think it was like 13 years old.

And had a double curve. The curves were, you know, relatively midline, so like under 30 degrees. So based off of an orthopedics recommendation, maybe not bracing, classification yet. And so this provider had managed this case a certain way and they actually saw some changes in the curve and the patient had gone on and not had any progression and not had any additional problems. And so when we were having this conversation, it's like, okay, so if we have a patient who's 13, they haven't gained a grown in six months, so they haven't gained any height in six months. They've had their menstrual cycle for two years. They're a Risser four.

They're almost done growing at that like 13 and a half. So they're like early in the stages, right? When you manage that scoliosis, they have a really low risk of it progressing. So it worked out well for them. But then on the flip side, there was another office that had a 13-year-old who hadn't had her menstrual cycle yet.

She was a Risser two, so she hadn't had her really fast growth phase yet, so she's still growing. And her curves were just under 30 degrees. So kind of in that same realm, they looked very similar, but there was a completely different history there because she had been growing in the last six months.

And so you stack all those things together and you've got a kid who hasn't had their menstrual cycle yet, which is so to backtrack. The onset of the menstrual cycle for the first like 18 to 24 months is when the most progression happens. If I didn't say that. So that's important to know. So if you haven't had your menstrual cycle yet, your growth plates are still at a Risser two, meaning you have a lot of growth left, you have been growing in the last six months.

Those curves are just like in those twenties, right under 30 degrees. That patient was managed in a very similar way, except in a four to five month period of time. That patient had progression and now is in a place, you know where they need a brace. So you can have two kids seemingly the same, but the underlying factors are different and you'll have two totally different outcomes.

And so you can't use this like box to kind of fit people in to what do you need to do with this? Because if you don't know the intricacy of all of the underlying factors. You really could guide somebody in a way that could be really detrimental to not just their health, but like leading to a surgery that could have been prevented.

And so some of these conversations are the things that I wanted to talk about because we do a lot in our office with bracing that maybe don't fit within the box, but we are able to really help people in ways that's, you know, outside of the box of what you might be able to get in a hospital or a different facility or a different bracing facility and things of that nature. So in addition to that, there's some other cases along with that where we talk about, you know, adults with degenerative cases where they're old enough now that, you know, surgeons don't really wanna touch it, they don't wanna do a fusion. It's not completely unstable in their spine, but it's affecting them day to day and they just don't have the ability to do the things they wanna do.

And so those are cases where we've done adult bracing for those cases, and we're not worried necessarily. About the cob angle. So when we talk about like, oh, you have a 45 degree curve. When we're looking at that, our goals are different. We're taking the patient in front of us and we're figuring out what can we do to help them with the things that are most important.

So if that same patient went to go see a surgeon, they're not likely going to brace an adult. They're not likely going to use their braces to be able to help with some of the things that they're experiencing. And most often they'll say, well, if it's not bad enough, we're not gonna do a surgery. So then patients are just left with not a whole lot of options other than you know, some traditional physical therapy and then eventually pain management, where we can have that same patient come into our office and we can have the conversation about, okay, what's, what are our goals here? And we've really been able to utilize that brace in a way that we can help adults have more stability.

We can use that brace to get more global balance, meaning that if we constantly feel like we're falling forward when we walk, we can help bring their body back and over their pelvis. But then we can also use that to help stabilize. So say they've got a double curve. They're leaning to their left or they're leaning to the right, we help stabilize and get them up upright and straight, and then we can utilize that brace to do some rehab and strengthening in that position.

And we've seen some great results where people that weren't able to even like bend over and tie their shoes or get their shoes off or be able to unload the dishwasher or even vacuum, are now able to do those things, or to pick up their grandkids. I can't tell you how many times I've had that conversation about, you know, well, I can't pick up my grandkids.

If I get down on the floor to play, I can barely get myself back up again. And so it may not be within the box of what the mainstream community might use, but we have been able to use the brace that we provide along with our rehab programs to really be able to help those people gain their quality of life back and their daily activities.

The same goes with different neurological conditions. So it may not be that, say, you know, we've got a patient with either like cerebral palsy or Parkinson's or MS or different neurological conditions that we know are associated with a higher incidence of scoliosis or hyper kyphosis.

Obviously we're not taking away the condition that's creating the scoliosis, right? So if we have cerebral palsy or if we have a different neurological condition that's creating a scoliosis, that condition's still going to be there, but we can provide a brace to help keep that patient more stable, more upright, keep their spine corrected while they're in their brace, and to help utilize that to gain strength and to create a rehab program that fits their specific situation that they can do, that can be really helpful.

And so out of all of those things, when we look at how we utilize our brace, there is an art to working with families and patients and finding the spot that really helps them utilize the tools that we have to get the results that they want. And it can be really confusing when you're hearing other things, but that's where I really want people to start to recognize that there's a different lens in which we're looking at that.

And so you have to take into consideration who you're seeing, where you're going, and what their lens might be and what they're looking at as far as what are they trying to prevent, and how are they giving you those recommendations. Because in that scenario I presented to you at the beginning, that family got three different recommendations.

And again, they were all accurate, but we have to come back to what are we trying to accomplish? What's important to the patient? What are our goals? And then based on those, how do we move forward? Because if your goal was simply to avoid surgery, or if your goal was to simply not have progression, then those recommendations are absolutely right.

Then you know what, you probably don't need a brace and you probably don't need to do rehab very often because you've pretty much already obtained those goals based off of where you're at. But if your goal is to reduce your pain and symptoms. Increase your activity to be able to have less injuries while you're playing sports, to correct your posture so that you're more comfortable with how your body looks and all of those things.

And to help reduce the curve so that long-term as an adult, it's less likely to progress and cause you problems, then those recommendations might not necessarily be the ones you want to follow. And so it's really about opening up the conversation within your family and other providers as well to understand the information about scoliosis and hyper kyphosis, what that means, and then how do you make your decisions off of that?

Because you can have recommendations that are completely different and also be accurate, but it may not fit what you want for you and your family and what your goals are. So this is a very in-depth conversation to have. But I wanted to just kind of scratch the surface of it to open up the conversation.

And I know that there's going to be people that listen to this and they're gonna say, well, what about fill in the blank? And so if you're one of those people that you're like, gosh, well what about this? I really do urge you to send us a message because those questions are important and I think having clarity or even knowing what to ask is really important.

And one of the things that we offer in our office is what's called the discovery call. So if you have a situation scenario that you're really looking for some guidance or just some information, if you reach out to us, we have a free 15 minutes discovery call where we chat with you. We get some information ahead of time and we can talk through the scenario to see, okay, is our office something you know, that's for you or do we feel like you need to be seen somewhere else? And then can we direct you to that place. And so it's really worth that conversation. We always have our website and on our socials you can send a message and we can connect with you that way. If you have any additional questions or if you want some more information, we can provide that.

We will be back in the next couple of weeks with some new episodes, and until then, I hope you have a great week.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

*****Resource Links You Need:

• Contact Dr. Mandy's office to learn how to work with her by calling (701) 223-8413 or email her at [email protected]. 
• Free Online Screening Tool: https://app.scoliscreen.com/
• Find out more about ScoliBalance® at https://scolicare.com/patients-scolibalance.
• Find out more about ScoliBrace® at https://scolibrace.com.